After Zarreen Perpall felt easily winded and exhausted she went to the hospital where doctors learned she had blood clots in her heart and lungs. While they rushed her into surgery to remove the clots, Perpall was stunned by the possible cause: a large uterine fibroid.
“I knew that there was something there. I didn’t know to what extent. I didn’t realize it was that big,” Perpall, 41, a camp and after-school program director from Brooklyn, told TODAY. “It was something I was following up on but not to the extent that this is what caused all this.”
Racing heart, exhaustion, easily winded
During the last weekend of August, Perpall was exhausted. Even small tasks left her winded.
“Walking around wore me out to the point that I needed to sit down constantly and catch my breath. My heart rate was racing, going to the bathroom was like running a marathon,” she said. “I’d have to get help coming back and just get in the bed and try to reset. But that never really happened.”
She visited her doctor who thought Perpall might need a blood transfusion for anemia. When she arrived at the emergency department, they ran tests and she had a CT scan. That’s when doctors discovered what caused Perpall’s weakness — she had blood clots in her heart and lungs. This past January she had deep vein thrombosis and was treated with medications. But her new diagnosis sounded scarier than the last one.
“It sounds like this was more than what I had in the past,” she explained. “So there’s fear and shock and ‘Shoot, why did this happen?’ All those things set in.”
She was transferred to Mount Sinai Morningside and she went into cardiac arrest during the surgery.
Clot treatment and a discovery
Dr. Omar Lattouf, cardiovascular surgeon at Mount Sinai Morningside, and his team treated Perpall. After they started surgery, Perpall started crashing.
“It started with our intervention radiation colleagues going in and successfully removing the clots that were in her right heart,” Lattouf told TODAY. “Shortly after that, she actually arrested. She dropped her blood pressure. Her heart rate went very, very low. We lost her but started CPR on her … for about two or three minutes. We got her back.”
But her blood pressure dipped again and they knew that they needed to move quickly to complete the pulmonary embolectomy, to remove the clot from her lungs. While it was a harrowing situation, Perpall is on the mend.
“She’s done very good,” Lattouf said. “She’s making great progress. She’s breathing comfortably. She’s back to almost her baseline with the understanding that she has to see a hematologist for further evaluation and probably surgical treatment.”
While doctors are still examining Perpall to understand why she experienced the clots at her age, Lattouf believes that the fibroid could be to blame. Because of its large size it could have disrupted blood flow.
“The mass was the size of, I want to say, the size of a large softball. So it’s possible that the uterine fibroids had something to do with that,” he said. “They could have compressed the inferior vena cava (large vein that carries blood to the heart) and iliac veins and caused sluggishness of the blood flow leading to clot formation.”
“If you think of the pelvic cavity, it’s a small area. And if you have a tumor that’s growing … it should be taken out,” Lattouf said.
While Perpall’s fibroid might have contributed to her health scare, this doesn’t occur often. Lattouf recalls only removing clots from a woman pregnant with twins where the uterus compressed the vena cava.
“Intra-abdominal masses, including pregnancy, creates an increased risk of clot formation,” he said.
People at greater risk of clot formation, including those with a family or personal history of deep vein thrombosis, should be aware that even benign masses in the abdomen could increase their risk for clots.
“They should be more aware and they should be seen by a hematologist,” Lattouf said. “The possibility of clot coagulation should be discussed with a hematologist.”
While Perpall will need to be followed by doctors for the rest of her life, Lattouf expects she will continue to improve. Lattouf applauds her for seeing her doctor when she was experiencing problems.
“Our vital signs tell us if we are in good health: blood pressure, heart rate, temperature,” he said. “For the layperson, if you’re having difficulty breathing, if you become lightheaded, feel you have heart palpitations, absolutely it’s always the safest to go to the emergency room. Don’t ignore those and don’t try to be your own doctor.”
Since surgery, Perpall has been in various therapies to recover. When she’s strong enough, she’ll have surgery to remove the fibroid.
“There was no pain. I wasn’t uncomfortable. There were times that my monthly cycle was heavier than normal but I’m over 40 and sometimes that happens,” she said. “No one said, ‘You need to take care of this and do this right now.'”
Having the fibroid removed will give her closure.
“I’m like, 'Let’s just get it done. Let’s get out everything that doesn’t need to be here,'” she said. “I can complete the recovery process.”
She’s sharing her story to encourage others to seek help when they’re feeling unwell.
“It’s important to share experiences, especially when it’s something that’s not necessarily talked about,” Perpall said. “It’s important to have someone that you’re comfortable speaking with about things like that and just listening to your body.”